2. Antifungals Flashcards
Candida albicans has two types of morphology, what are they?
- Oral yeast buds (commensualism)
2. Hyphae (tissue invasion) - the chronic variety that does not wipe off
Candida albicans - three factors to increase levels
- Prosthetic appliances (88%)
- Smoking
- Females
- Two forms of acute oral candidiasis
2. Can you wipe them off?
1. Acute pseudomembranous (thrush) Acute atrophic (erythematous)
- Yes, you can (so oral yeast bud/commensualism form)
Two forms of chronic oral candidiasis
- Chronic atrophic (denture stomatitis)
2. Chronic hyperplastic (candidial leukoplakia)
Oral candidiasis - four most common intraoral sites
- Tongue
- Buccal mucosa
- Palate
- Floor of mouth
Oral candidiasis - Five predisposing factors
- Endo/exocrinopathies
- Medications/drugs (antibiotics, chemotherapy, steroids)
- Nutritional deficiencies
- Hematologic/immune disorders
- Local factors (radiation, poor oral hygiene)
Systemic dissemination of oral candidiasis in the immunocompromised patient in which two sets of organs and valve?
- Esophageal and pulmonary
- Kidney, heart, brain, liver, eyes
- Prosthetic heart valve endocarditis
Nystatin (mycostatin)
- Mode of Action
- Indications?
- Route of admin?
- Side effects?
- Imidazole anti fungal (ergosterol disruption), so alters cell wall permeability2. Localized anti fungal infection
- Tablet/pastille, oral suspension, ointment, powder
- Minimal side effects
Clotrimazole (mycelia)
- Mode of action
- Indications?
- Side effects?
- What organ function needs to be monitored due to clotrimazole’s side effects?
- Imidazole anti fungal (ergosterol disruption), so alters cell wall permeability
- Local infections
- Nausea/vomitting, elevated AST (liver enzyme), teratogenic effect in mice and rats
- Liver function tests
Ketoconazole (Nizoral)
- Mode of Action
- How is it different from clotrimazole and nystatin?
- Indications?
- Requires what to be absorbed?
- Imidazole anti fungal (ergosterol disruption), so alters cell wall permeability
- Systemic antifungal
- systemic, disseminated, chronic mucocutaneous, localized
- Requires gastric acidity (no antacids, PPI’s, H2 pump inhibitors)
Ketoconazole (Nizoral) - Drug interactions (3)
- Terfenadine, astemizole (antacids)
- Antacids, H2 antagonists
- Omeprazole, lansoprazole (PPI’s)
Ketoconazole (Nizoral)- Side effects (5)
- Nausea/vomiting
- Hepatotoxicity (monitor liver function just like clotrimazole)
- Anaphylaxis
- Disulfram reaction (don’t take with alcohol)
- Avoid in breast feeding mothers
Fluconazole (diflucan)
- Mode of action?
- Indications
- Key differences (2) between fluoconazole and ketoconazole
- Interferes with P450, increasing cell wall permeability
- Systemic, localized
- Does not require gastric acidity and possibility of resistance
Fluconazole - Side effects (4)
- Nausea and vomiting
- Expensive
- Fungal resistance
- Avoid in breast feeding women
Fluconazole - Drug interactions 93)
- Terfenadine, cisapride
- Sulfonyureas (increase hypoglycemia risk)
- Coumadin (monitor PT/INR)
What is Dr. Monasky’s favorite anti-fungal to prescribe?
Fluconazole
- Fluconazole doesn’t require gastric acid
- Fluconazole doesn’t cause as much nausea as clotrimazol
What anti-fungal is considered the last line of defense due to its strength?
Itraconazole (sporanox)
Itraconazole (sporanox)
- Mode of action?
- Indications
- Two special factors?
- Blocks synthesis of ergosterol (triazole anti fungal)
- Chronic oral candidiasis
- Possibility of resistance and requires gastric acidity
Itraconazole (Sporanox) - Adverse reactions (4)
- Nausea and vomiting
- Hepatotoxicity
- Rash, Steven Johnson syndrome
- Avoid in breast feeding
Itraconazole (drug interactions)
- Terfenadine, cisapride, astemizole
- H2 blockers/PPI’s - omeprazoule, lansoprazole
- Coumadin (monitor PT/INR)
Amphotericin B (Funigzone)
- Mode of action
- Indications
- Drug interactions
- Modes of deliery
- Polyene fungal - binds to fungal cell membrane
- Localized (oral rinse)
- No significant drug interactions
- Oral rinse of IV formulation (only infectious disease specialists)
CHX (Peridex)
- Mode of action
- Do not prescribe with what other anti-fungal?
- Detergent activity on fungal lipid membrane
2. Do not prescribe with nystatin
Which antifungals out of this list are used localized (5) and which systemically (2)?
- Nystatin, clotrimazole, ketoconazole, fluconazole, itraconazole, amphotericin B, chlorhexidine
Localized: Nystatin, clotrimazole, itraconazole, amphotericin B, chlorhexidine
Systemic: Ketoconazole and fluconazole
Which antifungals are not given to breast feeding mothers? (3)
- Nystatin, clotrimazole, ketoconazole, fluconazole, itraconazole, amphotericin B, chlorhexidine
Ketoconazole, fluconazole, itraconazole
Which antifungals do you need to monitor PT/INR?
Fluconazole and itraconazole
Which antifungals do you need to monitor liver function?
Clotrimazole and Ketoconazole
